Related Experiment Video
Updated: Jul 22, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Association Between Thrombectomy and Functional Outcomes in Pediatric Patients With Acute Ischemic Stroke From Large
Kartik D Bhatia1,2, Samyami Chowdhury3, Ian Andrews4
1Department of Medical Imaging, Children's Hospital at Westmead, Westmead, Australia.
Insights
Mechanical thrombectomy significantly improves clinical outcomes for pediatric large vessel occlusion (LVO) stroke patients compared to conservative medical management alone. This finding supports thrombectomy as a viable treatment option for children with LVO stroke.
Area of Science:
- Neurology
- Pediatric Stroke
- Interventional Neurology
Background:
- Pediatric large vessel occlusion (LVO) stroke has historically poor outcomes.
- Mechanical thrombectomy (MT) shows promise but lacks robust clinical trial data in children.
- Randomized trials are challenging due to small patient populations and ethical considerations.
Purpose of the Study:
- To evaluate the efficacy of mechanical thrombectomy versus conservative management for pediatric acute LVO stroke.
- To compare clinical outcomes in children undergoing thrombectomy versus those receiving medical treatment only.
Main Methods:
- A matched case-control study utilizing pooled stroke registry data from 5 tertiary hospitals (Australia and Canada, 2011-2022).
- Included were pediatric patients (1 month to <18 years) with acute LVO stroke.
- Hierarchical matching (occlusion site, age, sex) was used to compare 31 thrombectomy cases with 46 controls.
Main Results:
- The study included 52 patients (31 male, mean age 10.3 years).
- Matched cohorts (26 thrombectomy, 26 controls) showed no significant baseline differences.
- Thrombectomy patients demonstrated superior 3-month functional outcomes (pediatric mRS) compared to controls (OR 3.76, P=.01), maintained at final follow-up (OR 3.65, P=.02).
Conclusions:
- Mechanical thrombectomy is associated with better clinical outcomes than medical management alone in pediatric patients with anterior circulation LVO stroke.
- This study provides evidence supporting thrombectomy for pediatric LVO stroke in the absence of randomized controlled trials.
- Findings are relevant for guiding treatment decisions in pediatric stroke care.
Importance:
Pediatric large vessel occlusion (LVO) stroke has a poor natural history. However, uptake of mechanical thrombectomy is hindered by a lack of clinical trial data in children. A randomized clinical trial is not feasible due to small sample sizes and absence of equipoise.
Objective:
To evaluate whether pediatric patients with acute LVO stroke who undergo thrombectomy have better clinical outcomes than matched patients managed conservatively.
Design, Setting, And Participants:
This matched case-control study used pooled stroke registry data from 5 tertiary referral hospitals in Australia and Canada from January 2011 to April 2022. Patients were aged 1 month to younger than 18 years with acute LVO stroke. Pooled data identified 31 thrombectomy patients and 46 control patients. Five patients undergoing thrombectomy with basilar artery occlusion were excluded due to insufficient controls. Using a hierarchal matching system (site of occlusion, age group, side of occlusion, and sex), deidentified consensus matching of patients and controls was undertaken while blinded to clinical outcome. Data were analyzed from July to November 2022.
Exposure:
In the case cohort, mechanical thrombectomy was undertaken for management of acute LVO stroke. The control cohort received medical treatment only.
Main Outcomes And Measures:
The primary outcome was the functional clinical status 3 months following stroke, measured by the pediatric modified Rankin Scale (mRS). Clinical outcomes were compared between groups using ordinal regression analysis.
Results:
Of 52 included patients, 31 (60%) were male, and the mean (SD) age was 10.3 (4.4) years. Matching was achieved for 26 children undergoing thrombectomy with 26 controls. There was no significant difference between groups for site or side of occlusion, age, sex, etiology, thrombolysis status, baseline Alberta Stroke Programme Early CT Score, or time since last seen well to presentation. Patients undergoing thrombectomy had superior clinical outcomes than control patients at 3 months on the pediatric mRS (odds ratio, 3.76; 95% CI, 1.32-10.67; P = .01). These superior outcomes were maintained at final follow-up (odds ratio, 3.65; 95% CI, 1.25-10.68; P = .02).
Conclusions And Relevance:
In the absence of a randomized clinical trial, this case-control study demonstrates better clinical outcomes with thrombectomy than medical management alone for pediatric patients aged 2 to 18 years with anterior circulation LVO stroke.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care